People who can’t take uric-acid-lowering medicines (because of kidney failure or drug allergy)

Postmenopausal women, especially those taking a diuretic. (Diuretics, used to treat high blood pressure, can raise uric acid levels.) (4)

Treatment for Tophaceous Gout and Tophi

Treatment for tophaceous gout typically involves long-term therapy with one or more uric-acid-lowering medications. (5)

Achieving and maintaining a uric acid level of 6 milligrams per deciliter (mg/dl) of blood or below can help reduce the risk of future gout flares. (6) These medications will also cause tophi to dissolve and disappear.

Uric-acid-lowering medications take time. It may take several months of treatment before uric acid levels start to go down.

Treating Gout and Tophi With Surgery

Uric-acid-lowering drugs can reduce the size of tophi over time. Some people may opt to have tophi surgically removed for cosmetic reasons. (7)

Your doctor may recommend surgical removal for tophi if they are causing mechanical problems with your joints.

Surgery for gout can help to reduce joint problems caused by tophi, including difficulty walking or nerve damage from tophi pressing against a nerve.

Tophi can erode through the skin, causing chronic ulcers that can become infected. These may require surgical removal.

Tophi removal is a relatively simple procedure. Your doctor will make a small incision on the skin over the tophi, remove the mass, and then suture the wound.

People with severe joint damage or bone loss around the joint may need additional joint replacement surgery.

The Link Between Gout and Kidney Stones

Excess uric acid can build up in the blood and form painful, spiky crystals. This may happen if the body is making too much uric acid or if the kidneys are having a hard time filtering it out.

In people with gout, the joints are the most commonly affected part of the body.

These spiky, urate crystals may also cause a stone to form in the kidney or other parts of the urinary tract.

Kidney stones can get stuck in the urinary tract and cause severe pain in the side of the abdomen or back. They pass out of the body in urine.

Kidney stones caused by uric acid crystals occur in about 15 percent of people living with gout. (4)

Uric acid gets excreted by the kidneys. Some medications aim at lowering uric acid levels by increasing the amount of uric acid excreted by the kidneys. These medications may increase the risk of kidney stones in some people. (4)

Talk with your doctor if you are using a uric-acid-lowering drug and are developing kidney stones. Your doctor may opt to put you on a different medication.

The Link Between Gout and Chronic Kidney Disease

Chronic kidney disease is a condition in which you slowly lose kidney function over time. The kidneys are important because they help remove waste products (such as uric acid) and urine from the body. (8)

People with chronic kidney disease are at an increased risk for gout, and people with gout are at an increased risk for chronic kidney disease, says the National Kidney Foundation. (9)

If the kidneys aren’t working properly, uric acid can build up in the body. That’s why kidney disease sometimes leads to high uric acid in the blood. High uric acid can cause gout.

One way that gout may contribute to chronic kidney disease is through kidney stones. People with recurrent kidney stones are at an increased risk for chronic kidney disease.

The National Kidney Foundation recommends that people with gout get checked for chronic kidney disease. (9) Your doctor may take blood and urine samples to test for it.

Doctors commonly use two tests to help diagnose the condition. A simple blood test, called a GFR, measures how much blood your kidneys filter each minute. A urine albumin test, or ACR, can help detect kidney damage. (9)

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